Provider Demographics
NPI:1831248921
Name:COOKE, JOHN D (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:COOKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N MILL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3979
Mailing Address - Country:US
Mailing Address - Phone:972-221-4243
Mailing Address - Fax:
Practice Address - Street 1:250 N MILL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3979
Practice Address - Country:US
Practice Address - Phone:972-221-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2120101YA0400X
TX101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral